Got Rhythm? Scapulohumeral Rhythm? If Not Your Rotator Cuff and Shoulder Joint Will Pay, Often With Impingement

Ahh...the wonderful complexity of the human body! The principles of human movement are relatively basic, but the organism and how it works is fantastically unique and complicated at times.

The sport does not matter, the activity does not matter, we must simply be able to move in a coordinated manner with joint alignment and muscular balance. Pretty easy, right? :)

Take a look at Rafael Nadal during his overhead serve

Or a volleyball serve

Even our feline friends

Just kidding:) The mechanics are pretty similar a the shoulder trying to get the arm into position to serve. You need rhythm, Scapulohumeral Rhythm!

A key muscle in the movement that is almost always weak and out of balance is the serratus anterior.

According to Kendall and McCreary, when the origin is fixed, the SA abducts the scapula, rotates the inferior angle of the scpulae laterally and the glenoid cavity cranially and holds the medial border of the scapulae firmly against the ribcage. The SA will also protract and slightly elevate the scapulae as well. If the insertion is fixed (by the rhomboids) the SA may act in forced inspiration. The SA will also prevent scapular winging.

So…as the humerus move, usually in 2:1 ratio the scapulae, the SA “sucks” or holds the scapulae to the ribcage as in glides through movements.

Often there is a muscular imbalance present with the pec minor leading the way to inhibit the serratus.

Levator scapula, teres major, latissiums dorsi, pec major should be looked at as well to name a few. In some cases the rhomboids can lock the scapulae in downward rotation and be overactive as well.

When a weak/under-active SA is present, and the SA cannot resist the pull of the deltoid during humeral abduction, scapular winging occurs. Winging can occur during static posture as well as during other movements. This can be a result of or cause shortening of the rhomboids since the rhomboids are antagonists of the SA. Once the force couple at the shoulder joint becomes dysfunctional altered recruitment strategies will present. Over-activity of the levator scap and pectoralis-minor are common imbalances. This can lead to impingement syndrome at the gleno-humeral joint once the scapulae has protracted. The biceps tendon in the Sagital plane and the infraspinatus tendon in the frontal plane will be at risk for impingement syndrome typically.

Aggravation of the bursae sacs may occur as well

To treat this situation with corrective exercise, I would of course begin with an integrated assessment. Then I would apply the corrective exercise continuum. I would maintain the protocol of; inhibit, lengthen, activate, integrate.

Here are some activation exercises.

“Push Ups with a plus” using most versions of a push up have p/c/a finish/complete each repetition at top of movement with protraction. I find having p/c/a use modified positions (on the wall from the knees) to be helpful (based on fitness level) so they do no have to manage their entire body weight at first. This technique during pressing movements has been helpful as well to engage the SA.

“Dynamic Hugs” or modified cable/tubing fly is another great way to engage the SA.

From a standing (or possibly seated) position, have p/c/a perform horizontal abduction (fly) with a slight bend in the elbows until hands touch, return slowly to staring position, repeat.

“Bench dips” have p/c/a keep elbows extended and active move from scapular elevation to depression with appropriate loads.

I have a few other favorites as well including alligator breathing to activate the diaphragm and "serratus push ups".

Integration would be the last step. Remember our body works as a functional unit and was must install and reinforce proper movement patterns/neuromuscular efficiency.

Squat to rows, squat to scaptions, step up to PNF, lunge to overhead press and kettlebell work can be great when done well. There is more to this scenario, but hopefully we can get some more people to focus on serratus anterior from here on in. So get your tennis players, baseball pitchers, volleyball players, house painters, plumbers, electricians and more an integrated assessment and some corrective exercise to help their rhythm! Thanks for reading! Eric Beard
Athletic Performance Enhancement Specialist
Corrective Exercise Specialist

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This entry was posted in impingement, injury prevention, rotator cuff, shoulder pain, tennis, volleyball. Bookmark the permalink. Post a comment or leave a trackback: Trackback URL.

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  1. By I Am My Shoulder’s Worst Enemy on September 24, 2011 at 6:39 pm

    […] Here’s a great explanation of scapular rotation from corrective exercise guru, Eric Beard. […]

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